Provider Demographics
NPI:1144305624
Name:PRISTAS, SANDRA (PT)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:PRISTAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1767
Mailing Address - Country:US
Mailing Address - Phone:732-223-2240
Mailing Address - Fax:732-223-9086
Practice Address - Street 1:606 UNION AVE
Practice Address - Street 2:
Practice Address - City:BRIELLE
Practice Address - State:NJ
Practice Address - Zip Code:08730-1831
Practice Address - Country:US
Practice Address - Phone:732-223-2240
Practice Address - Fax:732-223-9086
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00531800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist